I am a new manager on an oncology unit, and assessing various practices being performed. One concerns bone marrow biopsies. What pain management process are you using when performing a bone marrow biopsy? For example - moderate sedation.
Dec 22, '05
We use conscious/moderate sedation for BMA or bx - but it depends - some pt's don't want it - some do - it is of course up to the pt. The acual amount will vary for each person - if they have a higher tolerance due to current narc use etc.
All our sedation is done by nurses who have undergone a certification process, with biannual recert.
Dec 22, '05
We do our biopsies and aspirates in the clinic. The patient is not offered sedation at all. If they are opposed to the procedure they may take an Ativan . However, the procedure is done with a little local and offered Tylenol when the freezing starts to come out. Our patients tolerate the biopsies quite well.
Mar 30, '06
Just my opinions and what I have learned from experience:
To the people (docs) who don't offer meds, I would like to see them go through a BMBX without meds. I don't think that is humane. I have assisted with about 200 marrows and they HURT. And some pts have repeated marrows to evaluate treatment. Once is bad enough, but knowing it is coming again is worse. That is why IVP Ativan is nice: quick action, has some amnesia properties, and sedation.
The adult oncology clinic where I worked, we offered IV sedation for every marrow procedure. Usually Ativan. Some docs would give Ativan and an analgesic. If we were doing a biopsy on an inpatient in the hospital, they might give Versed in low doses. If the patient's didn't want it, that was fine, but they had the choice.
I can tell you that a bone marrow biopsey does hurt and the patients do get worked up thinking about it. There is no reason for the patients to have to suffer: offer medication. If you were getting a bone marrow, wouldn't you want some sedation/pain control?
May 10, '06
We utilize a wide variety pain control where I work. Some pts. want no more IV meds to some are sooo anxious the we end up using propofol to get their biopsies. Most frequently there is some combination of ativan/fentanyl/versed for conscious sedation. EMLA cream has been used occasionally with fair success.
Jun 3, '06
I work with children and young adults in oncology.Assisting in many biopsies, I also share the impression that they are very painful.
At bone marrow aspiration we use Midazolam for sedation and amnesia effects. Sometimes we also do analgesia with Piritramid , and we always do a local anesthesia with scandicain s.c. (which in my opinion is not necessary as the most pt complain about the pain of aspiration which can not be averted with that).
Jun 4, '06
I have had several bone marrow biopsies done. And there was nothing more than ibuprofen (I am allergic to tylenol) given.
It is uncomfortable and nerve wracking, but not nearly as uncomfortable as the bronch (w/sedation, but no initial pain med). I would not put it at excruciating compared to other procedures.
Many people have a poor pain tolerance. And most people getting BMBx done are :nervous, scared, sick, fatigued...and they may be getting them done repeatedly. Making them comfortable should be paramount. Many of them will have more painful, uncomfortable, scary procedures in the near future...let us be kind to them when we can.
Jun 26, '06
On our unit the pre-meds vary by patient. We usually offer ativan and dilaudid or morphine ahead of time. One of our practitioners that I've assisted several times makes sure that the patient is very well numbed. She takes a good 5 minutes to inject lidocaine at the site and on the bone. My personal experience with lidocaine as a patient for other procedures has been pretty uncomfortable and one of my docs buffers it with bicarb first to cut down on the initial sting. Distraction is also very important. Idle conversation helps, and only talk about the procedure to assess comfort level or to warn of the possibility of increased discomfort.
Jul 23, '08
I am a nursing student and I am unfortunately getting ready to have a BMB done. I know their are "patient rights to medication or pain relief". So I am wondering why my particular physician thinks that sedation is unnecessary?? After some convincing, he is sending me a prescription for Ativan to take PO 1 hr prior to arrival. Is this adequate, or should I see if I can get a valium from my PCP?? My hemo. told me that I could do that, but he wouldn't prescribe it for me. Anyway, if anyone has any suggestions, I'd appreciate it.
Jul 23, '08
I have assisted with many bone marrow biopsies and have rarely seen patients extremely uncomfortable. If you're very anxious, ativan will help. Also be assertive and ask the practitioner to be very generous with the lidocaine. The lidocaine does burn at first but once it gets in there the burning shouldn't continue. Everyone reacts differently but I can honestly say that the majority of the patients tolerate it very well.
Good luck with the procedure and I pray the biopsy turns out negative for you.
Aug 23, '08
I had my biopsy done, and it was simple. It may be the Dr. that makes the difference in pain vs. no pain. I just took the Ativan and he shot me up with Lidocaine, and it was over in minutes. No big deal. This is why they don't offer the conscious sedation in most settings. It's unnecessary.
The anxiety that is built up from reading all kinds of things about experiences on the internet is what makes patients freak out when they are there. And as nurses, we all know that anxiety and fear increase the intensity of pain.
Aug 24, '08
ativan and either morphine or dilaudid is our inpt normal
seems to work ok. we tinker with the amounts of each based on the pt
Aug 26, '08
On our unit we pre-med with ativan and morphine, then the physician injects lidocaine and waits for 5-10 minutes. I haven't seen a bad one yet.
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